|Title:||Developing and validating a model for predicting 7-day mortality of patients admitted from the emergency department: An initial alarm score by a prospective prediction model study||Authors:||MING-JU HSIEH
MATTHEW HUEI-MING MA
|Keywords:||Barthel index | emergency department | hospitalist | in-hospital mortality | prediction score | triage||Issue Date:||4-Jan-2021||Journal Volume:||11||Journal Issue:||1||Source:||BMJ Open||Abstract:||
© Objectives To set up a prediction model for the 7-day in-hospital mortality of patients admitted from the emergency department (ED) because it is high but no appropriate initial alarm score is available. Design This is a prospective cohort study for prediction model development. Setting In a tertiary referred hospital in northern Taiwan. Participants ED-admitted medical patients in hospitalist care wards were enrolled during May 2010 to October 2016. Two-thirds of them were randomly assigned to a derivation cohort for development of the model and cross-validation was performed in the validation cohort. Primary outcome measured 7-day in-hospital mortality. Results During the study period, 8649 patients were enrolled for analysis. The mean age was 71.05 years, and 51.91% were male. The most common admission diagnoses were pneumonia (36%) and urinary tract infection (20.05%). In the derivation cohort, multivariable Cox proportional hazard regression revealed that a low Barthel Index Score, triage level 1 at the ED, presence of cancer, metastasis and admission diagnoses of pneumonia and sepsis were independently associated with 7 days in-hospital mortality. Based on the probability developed from the multivariable model, the area under the receiver operating characteristic curve in the derivation group was 0.81 (0.79-0.85). The result in the validation cohort was comparable. The prediction score modified by the six independent factors had high sensitivity of 88.03% and a negative predictive value of 99.51% for a cut-off value of 4, whereas the specificity and positive predictive value were 89.61% and 10.55%, respectively, when the cut-off value was a score of 6. Conclusion The 7-day in-hospital mortality in the hospitalist care ward is 2.8%. The initial alarm score could help clinicians to prioritise or exclude patients who need urgent and intensive care.
|Appears in Collections:||醫學系|
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